Invitation to a Dialogue: Psychiatric Diagnoses

March 19, 2013

To the Editor:

Controversy surrounding the soon-to-be-released fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 — often called “psychiatry’s bible” — has cast a harsh light on psychiatric diagnosis. For psychiatry’s more radical critics, psychiatric diagnoses are merely “myths” or “socially constructed labels.” But even many who accept the reality of, say, major depression argue that current psychiatric diagnoses often “stigmatize” or “dehumanize” people struggling with ordinary grief, stress or anxiety.

We can certainly debate the legitimate boundaries of disease and “normality,” as in the controversy over “normal grief” versus major depression after a recent bereavement. But there is nothing inherently dehumanizing or “stigmatizing” about a psychiatric diagnosis. Ironically, such inflammatory charges only worsen society’s animus and prejudice toward those with mental illness, by implying that having a psychiatric disorder is grounds for shame. Diagnoses in other medical specialties rarely provoke such a reaction.

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CreditMarion Fayolle

Critics typically reply that other medical specialties have “objective” criteria for diagnosis of disease, whereas psychiatrists merely apply “labels” to behaviors they (or society) find offensive. But in truth, numerous medical and neurological diagnoses, such as migraine headache, are based on the same type of data that psychiatrists use: the patient’s history, symptoms and observed behaviors. I believe that psychiatric diagnoses are castigated largely because society fears, misunderstands and often reviles mental illness.

“Diagnosis” means knowing the difference between one condition and another. For many patients, learning the name of their disorder may relieve years of anxious uncertainty. So long as diagnosis is carried out carefully and respectfully, it may be eminently humanizing. Indeed, diagnosis remains the gateway to psychiatry’s pre-eminent goal of relieving the patient’s suffering.

RONALD PIES Lexington, Mass., March 18, 2013

The writer is a professor of psychiatry at SUNY Upstate Medical University and Tufts University.

Editors’ Note: We invite readers to respond by Thursday for the Sunday Dialogue. We plan to publish responses and Dr. Pies’s rejoinder in the Sunday Review. E-mail: letters@nytimes.com

A version of this article appears in print on , on Page A26 of the New York edition with the headline: Invitation to a Dialogue: Psychiatric Diagnoses. Order Reprints | Today’s Paper | Subscribe